摘要:

ObjectiveTo determine whether the order of cell collection, endocervical or ectocervical cells first, has an effect on the quality of the Papanicolaou smear.MethodsOne thousand smears were obtained using an Ayre spatula and an endocervical brush. In 500 cases the endocervical brush was used first, and in 500 cases the spatula was used first. All Papanicolaou smears were collected by resident physicians in our university hospital gynecologic clinics. A smear was considered limited for interpretation for the following reasons: 1) lack of endocervical component, 2) obscured by blood, 3) obscured by inflammation, 4) drying artifact, and 5) too thick.ResultsThe brush-first group had 405 (81%) adequate smears compared with 410 (82%) adequate smears in the spatula-first group. More smears were obscured by blood when the brush was used first (22 or 4.4% compared with three or 0.6%,P<.001). No endocervical component (ie, metaplastic cells, endocervical cells, or mucus) was found in 29 (5.8%) smears from the brush-first group compared with 45 (9.0%) of the spatula-first group, an insignificant difference. More squamous intraepithelial lesions were found when the spatula was used first (55 or 11% compared with 35 or 7.0%,P<.05).ConclusionThe quality of the Papanicolaou smear can be improved by using the Ayre spatula first followed by the endocervical brush. Fewer smears will be obscured by blood, which could result in more squamous intraepithelial lesions being detected.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo quantify the risk of residual invasion when cervical conization reveals microinvasive squamous carcinoma and to determine whether any factors affect this risk.MethodsWe reviewed the charts and histopathology slides of 87 women who underwent a conization that contained microinvasive squamous carcinoma, followed by either a repeat conization or hysterectomy. Depth of invasion, number of invasive foci, and status of the internal margin and post-conization endocervical curettage (ECC) were assessed. The findings were correlated with the presence of residual invasion.ResultsSignificant predictors of residual invasion included status of the internal margin (residual invasion present in 22% of women with an involved margin versus 3% with a negative margin;P<.03) and the combined status of the internal margin and post-conization ECC (residual invasion in 4% of patients if both negative, 13% if one positive, and 33% if both positive;P<.015). Depth of invasion and number of invasive foci in the conization specimen were not significant. The power of this study to detect a 25% difference in the risk of residual invasion was 73% for depth of invasion and 75% for number of invasive foci.ConclusionWomen with microinvasive squamous carcinoma in a conization specimen in which both the internal conization margin and post-conization ECC are negative have a low risk of residual invasion and are candidates for follow-up or simple hysterectomy. If either the internal margin or the post-conization ECC contains dysplasia or carcinoma, the risk of residual invasion is high and warrants repeat conization before definitive treatment planning.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo review our experience and that in the recent literature regarding basal cell carcinoma of the vulva to see whether current management guidelines are appropriate.MethodsTwenty-eight women with basal cell carcinoma of the vulva were seen over 25 years at the BC Cancer Agency. The clinical-pathologic features were tabulated and the outcome was analyzed.ResultsThe mean age was 74 years, and almost two-thirds were over the age of 70 at diagnosis. Patients typically presented with an irritation or soreness, with a symptom duration ranging from a few months to several years. Most lesions were confined to the anterior half of the vulva, and 23 of the 28 patients had T1 lesions. Wide local excision was the treatment method used most commonly. Only one patient was known to have died from disease metastasis. Ten women had other basal cell carcinomas, either before or after the diagnosis of their vulvar lesions, and in ten patients 11 other malignancies were diagnosed.ConclusionBasal cell carcinoma of the vulva is an extremely uncommon tumor that rarely metastasizes or spreads. Primary treatment should consist of wide local excision and continued follow-up.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo investigate to what extent a newly revised educational pamphlet on triple-marker screening improves patient knowledge and to identify subgroups of women who may not benefit from these materials.MethodsWomen in six geographically and demographically diverse Ontario sites were allocated randomly to receive the pamphlet on triple-marker screening or a similarappearing educational pamphlet on daily activities during pregnancy. The primary outcome measure was the Maternal Serum Screening Knowledge Questionnaire, a previously validated 14-item scale.ResultsBaseline demographic, obstetric, and medical factors were comparable in the intervention and control groups, as were measures of previous exposure to triplemarker screening. Knowledge scores were significantly higher among the 133 women receiving the intervention pamphlet than among 64 women who received the control pamphlet (0.89 versus 0.52 on a scale from −2 to +2,P<.001). Subgroups not benefiting from the pamphlet on triplemarker screening were women age 25 and younger and those not speaking English at home. Those who had completed university or postgraduate education had high levels of knowledge with and without the pamphlet.ConclusionWritten patient information can contribute in an important way to patient knowledge about triple-marker screening. Providers of antenatal care should be made aware of the value of written patient information as well as the limitations for some subgroups of women. These subgroups are likely to require additional educational materials and resources. It would be appropriate to make these materials available to the general public and pregnant women in their physicians' offices.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the efficacy of subcutaneous terbutaline therapy on the success rate of external cephalic version in term gestation.MethodsWomen with singleton noncephalic gestations were assigned randomly to receive either terbutaline (0.25 mg) or placebo. Physicians were blinded to the assignment. Fifteen to 30 minutes after the study drug was administered, external cephalic version was attempted. It was discontinued after three attempts, for patient discomfort, for fetal heart rate decelerations, or when successful. Patients were discharged home after the procedure and allowed to enter spontaneous labor. Primary outcomes evaluated included initial success of version, presentation in labor, and route of delivery.ResultsOne hundred three women were enrolled in the study between January 1994 and June 1995, of whom 52 were assigned to terbutaline and 51 to placebo. External cephalic version was successful in 27 of 52 (52%) women receiving terbutaline compared with 14 of 51 (27%) of those receiving placebo (P= .019). This comparison yielded a relative risk (RR) of 1.9 (95% confidence interval [CI] 1.3, 6.5). Four of the 27 (15%) successful versions in the terbutaline group and three of the 14 (21%) successful versions in the placebo group spontaneously reverted to breech presentation. Ultimately, in labor there were 24 (46%) cephalic presentations in the terbutaline group and 13 (25%) in the placebo group (P= .048, RR 1.84, 95% CI 1.1, 5.8). Cesarean delivery rates were 11 of 41 (27%) for women with successful versions and 58 of 62 (94%) among those with failed versions (P<.001).ConclusionTerbutaline (0.25 mg) administered subcutaneously before an attempted version in women at term with noncephalic presentations significantly increased the initial success rate of version and the rate of cephalic presentations in labor while decreasing the rate of cesarean delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the relationship of multiple maternal and cord blood correlates of newborn size to determine the relative strength of the insulin-like growth factor-I association.MethodsThirty-seven venous cord blood specimens were obtained at the time of delivery. Ponderal index and birth weight percentile were calculated at birth. Neonatal length estimates were performed with a measuring board. All mothers were nonsmokers and had normal glucose tolerance. There was a wide range of maternal prepregnancy body mass indexes (BMI) (19.6–43.4). Neonates had a wide range of ponderal indexes (2.12–2.75) and birth weight percentiles (7–99th percentile). Univariate correlation coefficients were calculated to determine simple relationships. Stepwise linear regression analyses were performed to determine the relative contribution of potential explanatory variables to both ponderal index and birth weight percentile. Potentially explanatory independent variables included maternal prepregnancy BMI, weight gain in pregnancy, and maternal insulin sensitivity at 32 weeks' gestation. Maternal insulin sensitivity was estimated using the minimal model technique. Neonatal variables included sex, cord blood albumin, insulin, insulin-like growth factor-I, insulin-like growth factor-binding protein-1, and insulin-like growth factor-binding protein-3.ResultsSignificant positive univariate correlations were identified between cord blood insulin-like growth factor-I and insulin-like growth factor-binding protein-3 with neonatal ponderal index and birth weight percentile. Maternal insulin sensitivity demonstrated a negative correlation with birth weight percentile (r= −.35,P<.05). Cord blood insulin correlated positively with birth weight percentile (r= .32,P<.05). There were no significant associations of cord blood insulin-like growth factor-binding protein-1 or albumin with either index of newborn size. Stepwise logistic regression analysis demonstrated an independent association of insulin-like growth factor-I with ponderal index (r2= .41,P<.001). Both insulin-like growth factor-I and male sex were associated independently with birth weight percentile (r2= .38,P<.001). No additional independent variables contributed to the prediction of ponderal index or birth weight percentile.ConclusionThese data support a unique relationship between cord blood insulin-like growth factor-I and newborn size under normal growth conditions. This is manifest by the strength and independence of the association between insulin-like growth factor-I and neonatal birth weight percentile ponderal index.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare cervical dilation and the Bishop score as correlates of successful labor induction and vaginal delivery and to determine whether the prognosis of postripening cervical characteristics varies with the method of ripening used.MethodsFour hundred forty-three women with Bishop scores less than 9 who required induction of labor were assigned randomly to cervical ripening with prostaglandin E2 gel or hygroscopic dilation. The Bishop score and its component characteristics were evaluated as univariate correlates of successful induction of labor and vaginal delivery and then were assessed using logistic regression to adjust for other maternal and fetal factors. The differences in the association between method of ripening and successful labor induction were evaluated relative to pre-ripening and post-ripening cervical examination characteristics.ResultsCervical dilation was a better correlate of successful labor induction and vaginal delivery than was the Bishop score, even after exclusion of patients with initial Bishop scores greater than 6 and dilation greater than 3.0. Both ripening methods yielded similar success in labor induction and vaginal delivery, but when categorized by post-ripening cervical examinations, patients undergoing hygroscopic ripening had lower rates of successful labor induction and vaginal delivery.ConclusionCervical dilation is a better predictor of successful labor induction and vaginal delivery than either the Bishop score or any other Bishop score component characteristic. The likelihood of successful labor induction and vaginal delivery based on post-ripening cervical characteristics varies by the ripening method used.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine prevalence rates and psychosocial correlates of clonidine use in a sample of opiate-dependent pregnant women.MethodsClonidine use was assessed in 90 treatmentseeking, pregnant, opiate-abusing women using both selfreport and urinalysis toxicology. Clonidine-positive and -negative subjects were compared for selected demographic, substance use, and psychosocial measures.ResultsOne-third of the sample was clonidine-positive. Urinalysis identified 26 clonidine-positive subjects, whereas self-report detected only six cases. Logistic regression identified four predictors of clonidine use at treatment admission: recent clinical anxiety, greater severity of family or social problems, recent cocaine use, and recent drug treatment.ConclusionClonidine use is prevalent in treatmentseeking opiate abusers, particularly those with concurrent cocaine use. The abuse potential of the drug warrants further study in this high-risk population.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess uterine and fetal blood flows by Doppler velocimetry and fetal growth and oxygenation in pregnant ewes treated daily with cocaine and to determine whether cocaine impairs fetal cardiac and cerebral reactivity.MethodsThe study groups received 70 mg (n= 7) or 140 mg (n= 7) of cocaine and the control group (n= 7) received placebo injected intramuscularly daily on days 60–134. Hemodynamic data were measured at rest and during two acute hypoxic tests at cesarean delivery performed on day 134.ResultsThe fetal heart rate (FHR) and umbilical and uterine resistance indices (RIs) were higher in the cocaine groups than in the control group (FHR: 187 ± 8 and 166 ± 8 beats per minute at 83 and 123 days, respectively, in controls and 9–11% higher in cocaine groups; umbilical RI: 0.79 ± 0.06, 0.60 ± 0.04, and 0.52 ± 0.06, at 83, 105, and 123 days, respectively, in controls and 11–17% higher in the cocaine groups [P<.01]; and uterine RI: 0.40 ± 0.05, 0.40 ± 0.04, and 0.37 ± 0.04, at 83, 105, and 123 days, respectively, in controls and 13–35% higher in cocaine groups [P<.05]). At delivery on day 134, the following characteristics were found to be different in the cocaine groups: fetal weight (4.03 ± 0.2 kg in controls and 15–21% lower in the cocaine groups [P<.02]), partial pressure of oxygen (26.5 ± 1.4 mmHg in controls and 15–16% lower in cocaine groups [P<.05]), umbilical RI (0.40 ± 0.03 in controls and 11–17% higher in cocaine groups [P<.01]), cerebral RI (0.61 ± 0.03 in controls and 9–15% lower in cocaine groups [P<.01]), and cerebral-umbilical ratio (1.52 ± 0.04 in controls and 22–23% lower in cocaine groups [P<.001]). During the hypoxic tests, the cerebral RI (P<.05) and the cerebral-umbilical ratio (P<.05) decreased significantly less in the two cocaine groups. The FHR response was reduced significantly less in the two cocaine groups (P<.05).ConclusionLong-term exposure to cocaine induces uterine and fetal blood flow disorders, fetal growth restriction, and hypoxia. It reduces the capability of the cerebral vessels to vasodilate and the heart rate to increase during acute hypoxia.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine neonatal survival, short-term morbidities, and cost per survivor in pregnancies delivered at 24–26 weeks' gestation in a center in which antenatal steroids and exogenous surfactant are standard care.MethodsA retrospective cohort study compared survival, short-term outcome, and initial hospital charges for pregnancies delivered at 24–26 weeks during 1990–1994. We calculated hospital costs for each year by using the corresponding institutional cost-charge ratio.ResultsThere were 138 infants after excluding those with severe anomalies. Survival was 43%, 74%, and 83% at 24, 25, and 26 weeks, respectively (P= .006). The majority of women received antenatal steroids, and the majority of surviving neonates received exogenous surfactant. Severe retinopathy of prematurity and chronic lung disease decreased significantly from 24 to 26 weeks (P≤ .026). The likelihood of having a surviving infant without chronic lung disease or severe retinopathy of prematurity was 35% at 24 weeks and 78% at 26 weeks. Hospital costs for the 29 nonsurvivors were $1.46 million and for the 94 surviving infants were $16.9 million. The cost per day was similar at each gestational age, whereas the cost to produce a survivor was $294,749, $181,062, and $166,215 at 24, 25, and 26 weeks, respectively.ConclusionSurvival at 24 weeks was only 43% despite treatment with antenatal steroids and exogenous surfactant. The cost per survivor for infants born at 24 weeks was higher than the cost for those born after 1 more week in utero. Outcome improved markedly between 24 and 26 weeks, and small differences in gestational age lead to large economic differences. All efforts should be attempted to prolong pregnancy, and if prolongation is unsuccessful, treatment options including nonintervention should be available to parents of 24-week gestations.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID